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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Elorward <br /> Sanitary Landfill S&ary Landfill Sanitary edfill Landfill <br /> 901 Bailey Road 12M San Mateo Road 1601 Dixon La Ing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas, CA 95035 Manteca,CA 95336 <br /> Phone (925)458-9800 Phone(650)726-1819 Phone(408) 945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(650) 726.9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST + <br /> GENERATOR .} WASTE ACCEPTANCE NO. <br /> x2Ci'C- i�A +- �IeCtrf Ce r <br /> MAILING ADDRESS q <br /> '77 ew.le- 517 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> sistui -rr4t^ . , 01,4, cf 11 ?' ❑GLOVES O GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHONE <br /> Llj, q73 7 7 "/: ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> w r 1—>`rP r t, 1, <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OFAUTHORIZED <br /> aAGENT/TITLE DATE <br /> Jf <br /> GENERATOR' CERTiRCAftON:I hereby certiy that the above named material is not a hazardous <br /> .sets as define by 40 CFR Pad 261 or title 22 of the California tale of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,It the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the and Disposal Restrictions.I cenly and warrant that the waste has been treated in RECEIVING FACILITY <br /> a—mimic,with the requirements of 40 CFR Part 266 and Is no longer a hazardous waste as defined by <br /> 40 CFR Part 1. <br /> WASTE,TYPE: <br /> 17Y5lSPOSAL ❑SLUDGE <br /> O CONSTRUCTION O WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 21 Hi <br /> TRANSPORTER NOTES: I VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Or yt ,. -�-� 9b�od.�z 7 <br /> ADDRESS <br /> 0 <br /> CITY, STATE,ZIP <br /> C/9 s <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> p 70 <br /> 7 ❑ ❑ ❑ <br /> SIGNATUREOFAUTH RIZEDAGENTORDRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> / A/' ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> fy that the above named material has been <br /> to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> ❑ SOIL <br /> IF17EMARK <br /> O CONSTRUCTION <br /> NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> UTHORIZED AGENT DATE <br /> % 7 J ❑WOOD <br /> ❑ASH <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRICRTO 3:OG P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGGING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST 8 J <br /> TRANSPORTER COPY <br />